Mastering menopause

Navigating “the change”

Have you heard the one about the Carmel woman who adopted a baby at age 44 and said to her sister, “How ironic that I’m sitting here rocking my baby at the same time I’m having to fan my hot flashes.” Her sister replied, “Yes, but if you hadn’t brought home the baby, you’d just be sitting here hot flashing.” True story.

Five years later she's still mopping her brow, but not nearly as often — a blessing she attributes to vigorous exercise, infrequent intake of alcohol, and a daily dose of bio-identical hormones. If she could figure out how to eliminate the hair dryer, her hot flashes might disappear altogether. But that's her story. Some women would have pushed through to the cool side of menopause by now. Most others her age would not have even begun the journey.

"Menopause is the end of a woman's natural menstrul cycle, which occurs when all the eggs in the ovaries have been ovulated," says Stephanie Taylor, a Carmel gynecologist. "Once the woman has run out of eggs, menopause occurs. When it happens depends on how many eggs a woman is born with. The average age is 51, but it can be two or three years on either side of that.

Or more. Some women enter menopause very early, others quite late. About 50 percent of women will have mild symptoms that don't need treatment, says Taylor. Others will experience some significant symptoms that need to be addressed. Generally, the duration of symptoms is approximately three years. If you look to both ends of the spectrum, however, you will find hot flashes in some women as much as 10 years before menopause, and some women will have them into their 80s.

"The most common problem," says Taylor, "is the hot flashes, particularly if they disturb sleep. We thought we knew what causes them; but under careful investigation, we find we have no idea. We do know that certain things reliably trigger hot flashes: emotional stress, alcohol, hot drinks, spicy foods, use of a hair dryer, and hot weather among them. The moral of the story is that it's better to live in Monterey than in Phoenix during menopause."

Secondary symptoms include a fuzzy brain, a feeling of exhaustion, loss of zest for life, dry skin, and mood swings. The traditional antidote to menopause has been hormone replacement therapy (HRT) to mitigate symptoms, protect bone structure and guard against heart disease. Yet five years ago, after a major medical study raised serious concerns about the use of hormone drugs, many women stopped HRT cold.

"The study was the Women's Health Initiative, a primary prevention study," says Taylor. "But the participants were, on the average, 10 years into menopause at the time they started the study. And some had pre-existing heart disease or undiagnosed breast cancer during the five years before. These things became more apparent throughout the study, but unanswered question is whether this would be true for women who started taking estrogen at the beginning of menopause or for those who didn't have these pre-existing conditions."

Five years later, says Taylor, after reanalyzing that original data, researchers have confirmed a reduction in mortality among women on hormones, as compared to those taking placebos.

"The biggest concern associated with taking estrogen," says Taylor, "is the risk of breast cancer. But there shouldn't be an undue focus on this. The risk is real but small, and it appears to go up with increasing length of use. However, for some women, it's an acceptable risk if the menopausal symptoms are severe. The most worrisome is poor quality sleep due to hot flashes, and the fatigue that ensues."